Scaling & Root Planing (D4341)
If the patient has attachment loss, moderate pocketing, and detectable calculus, then root planing is appropriate therapy. Use D4341 if four teeth or more are involved. You will need to anesthetize the patient to do the subgingival scaling and root planing. Only if the patient specifically refuses the use of anesthetic should you not use it.
Limited Root Planing (D4342)
If only a few teeth (<3) in a quadrant have pockets (4 mm or greater), loss of attachment, inflammation and subgingival calculus, you can treatment plan the quadrant for limited root planing. Do scaling and root planing on all of the necessary teeth, and scaling only on the uninvolved teeth. Teeth that are root planed must be identified in the treatment note for limited root planing.
Re-evaluation / Initial Treatment Evaluation (D0170)
Root planing is always followed by a re-evaluation 4-6 weeks post treatment (although 2-8 weeks is acceptable). Failure to re-evaluate periodontal patients is a failure to practice within the standard of care. If you have a patient who has already received root planing and is on maintenance therapy, you will only need to perform re-evaluation if the condition is not stable or if the pockets and/or attachment loss are increasing. One of the purposes of the re-evaluation is to see how the patient has responded to the therapy and if their home care has improved. This information will help you determine whether periodontal surgery is necessary, and the recall frequency.
SPT (Supportive Periodontal Therapy) (D4910)
Once a patient has undergone root planing and the periodontal condition is stable, a recall frequency is established. The patient
will usually be treatment planed for a SPT at recall. A SPT is defined as procedures performed at selected intervals to assist the periodontal patient in maintaining oral health. Maintenance procedures are under the supervision of the dentist and typically include an update of the medical and dental histories, radiographic review, extraoral and intraoral soft tissue examination, dental examination, periodontal evaluation, removal of the bacterial flora from crevicular and pocket areas, scaling and root planing where indicated, polishing of the teeth, and a review of the patient's plaque control efficacy. Periodontal maintenance procedures following active therapy is not synonymous with a prophylaxis (Glossary of Periodontal Terms; 4th Edition, 2001). A recall exam (D0120) must be scheduled every time a patient is due for a SPT (D4910) visit. The SPT will be treatment planned at the recall exam if still appropriate. This means D0120 may be necessary 4 times per year for some patients.
For patients who have no active attachment loss (healthy periodontium or gingivitis) you will treatment plan a prophy. A prophylaxis is defined as the removal of plaque, calculus, and stains from the exposed and unexposed surfaces of the teeth by scaling and polishing as a preventive measure for the control of local irritational factors (Glossary of Periodontal Terms; 4th Edition, 2001).